Healthcare Provider Details

I. General information

NPI: 1790517704
Provider Name (Legal Business Name): JENNIFER BATROUS HOLLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2024
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12339 OAK FIELDS DR
GEISMAR LA
70734-3170
US

IV. Provider business mailing address

12339 OAK FIELDS DR
GEISMAR LA
70734-3170
US

V. Phone/Fax

Practice location:
  • Phone: 225-279-6310
  • Fax:
Mailing address:
  • Phone: 225-279-6310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP239730
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN146013
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: